title: Supratentorial ependymoma in children: to observe or to treat following gross total resection?
abstract: BACKGROUND
  The standard treatment for ependymoma is surgical resection followed by postoperative irradiation to the local site. The role of radiation therapy in completely resected supratentorial ependymoma has been questioned over the past two decades.
  
  
  METHODS
  Retrospective review of the medical records of all consecutively diagnosed supratentorial ependymoma patients at Children's Hospital Los Angeles between January 1999 and December 2009.
  
  
  RESULTS
  Ten patients (three females) were included. The median age at presentation was 5.6 years (range 1.8-15.6 years). Reviewed histology was anaplastic ependymoma in seven patients and cellular ependymoma in three patients. Gross total resection was achieved in six patients; five were observed and one received chemotherapy. In the four patients who underwent subtotal resection, one was observed, two received local irradiation and one received irradiation and chemotherapy. The median length of follow up was 43 (range 22-81) months. Four relapses were observed; two patients who underwent initial gross total resection. All patients who underwent gross total resection were alive at the time of preparation of this article. The 5-year progression-free and overall survival rates were 53 ± 19% and 86 ± 13% respectively.
  
  
  CONCLUSIONS
  Radiation therapy was avoided in five patients following gross total resection, four of whom had anaplastic histology. In some children with completely resected supratentorial ependymoma, surgery alone may be an acceptable treatment option.
authors.affiliation: Division of Hematology/Oncology, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA. rvenkatramani@chla.usc.edu
authors.forename: Rajkumar
authors.initials: R
authors.lastname: Venkatramani
authors.forename: Girish
authors.initials: G
authors.lastname: Dhall
authors.forename: Moneil
authors.initials: M
authors.lastname: Patel
authors.forename: John
authors.initials: J
authors.lastname: Grimm
authors.forename: Cynthia
authors.initials: C
authors.lastname: Hawkins
authors.forename: Gordon
authors.initials: G
authors.lastname: McComb
authors.forename: Mark
authors.initials: M
authors.lastname: Krieger
authors.forename: Kenneth
authors.initials: K
authors.lastname: Wong
authors.forename: Sharon
authors.initials: S
authors.lastname: O'Neil
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Finlay
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D004806:Ependymoma / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011182:Postoperative Care; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012189:Retrospective Studies; D015173:Supratentorial Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D016019:Survival Analysis; D057832:Watchful Waiting